Recurrent Vascular Events and Death following Small Vessel Ischemic Stroke in the Short, Intermediate and Long-term over 8 Years (P1.042)

Objective: To investigate the prognosis and predictive factors among patients with small vessel ischemic stroke in terms of recurrent vascular events and death serially over 8 years. Background: Small vessel ischemic stroke has better outcomes compared to other stroke subtypes in the short-term. However data on serial and long-term outcomes are limited. Methods: We studied ischemic stroke patients from the Multi-Centre Retinal Stroke Study with small vessel etiology defined by the TOAST classification. Follow-up via telephone interview and chart review for recurrent stroke, coronary event, composite vascular event (stroke, coronary event or vascular death) and overall death was perfomed serially over a maximum duration of 100 months (8.3 years); at 6 months, at a median of 29 months (2.4 years) and a median of 86 months (7.2 years). Survival analyses were performed with the Life Test procedure. Results: There were 323 stroke patients with small vessel etiology, 40[percnt] of the 806 patients in the overall MCRS cohort. The percentage survival at 12, 60 and 90 months was 92[percnt], 74[percnt] and 65[percnt] for composite vascular events; 93[percnt], 82[percnt] and 77[percnt] for recurrent stroke; 99[percnt], 91[percnt] and 85[percnt] for coronary events; and 98[percnt], 87[percnt] and 80[percnt] for overall death. The predictors of composite vascular events (HR with 95[percnt] CI) were diabetes (1.70, 1.10-2.64) and atrial fibrillation (10.99, 1.30-92.90); for recurrent stroke were previous stroke (1.99, 1.04-3.78) and atrial fibrillation (10.32, 1.18-90.31); for overall death were age (1.08, 1.04-1.11) and diabetes (2.02, 1.14-3.59). Conclusions: There is a decreasing pattern of survival from recurrent vascular events and death among small vessel stroke patients, which persists over at least 8 years, leading to 1/3 having a recurrent vascular event and 1/5 being dead by 8 years. The long-term prognosis of small vessel stroke is not benign and specific secondary vascular prevention should be further explored. Disclosure: Dr. De Silva has nothing to disclose. Dr. Fabiana has nothing to disclose. Dr. Allen has nothing to disclose. Dr. Woon has nothing to disclose. Dr. Chang has nothing to disclose. Dr. Ikram has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Wong has nothing to disclose.